Connection to the cycler

• You and your child are a team. Encourage autonomy by making realistic choices about what they can do to help you.
• Make the care part of a routine.

• Prepare the environment: Identify a place to perform the treatment.
• Prepare your child:
• Get help if needed.
• Position your child to safely assess the catheter insertion site in one of the positions discussed with your healthcare team, based on your child’s comfort, age and ability to cooperate.
• Begin distraction strategies. 
• Prepare yourself: Choose a time when you are ready to do the treatment. Review the method.
• Perform basic procedures, as taught by your healthcare team:
  • Wash your hands with soapy water for at least 20 seconds.
  • Dry your hands well with a clean paper or towel.
  • Close the tap with the paper or towel.
  • Close doors and windows or ventilation system.
  • Wash your working surface (eg., table) with alcohol or a disinfectant wipe (eg, Sani-Cloth® Plus).
  • Let the table dry.
  • Gather and inspect materials.
  • Put on a mask.
  • Remove jewelry.
  • Wash your hands with a 4% chlorhexidine soap solution for 2 minutes.
  • Dry your hands well with a clean paper or towel.
  • Close the tap with the paper or towel.
• Now touch only the dialysis equipment.
• Now that you are ready to begin the treatment, take the opportunity to congratulate your child and offer encouragement during the rest of the procedure.

See the full description here

Summary 3 key concepts:

• Safety: Carefully follow the care practice steps as you have been taught.
• Flexibility: Be ready to adjust according to your child’s reactions during the procedure. As needed, reposition or select an alternative distraction strategy. Follow your child’s pace and rhythm.
• Collaboration: Reassure your child, verbally and non-verbally. Acknowledge your child’s emotions and reactions. Help your child differentiate between the different sensations during a procedure.

• Make sure that the cycler and cassette assembly is complete and that there is no air in the patient line.
• Make sure that the catheter extension is properly closed: the two half-moons of the white part and the light blue part must be well aligned and nested in each other.

This step prevents contamination with air and fluid in the patient line.

• Open the sterile compresses package.
• Open the disinfectant pad package.
• Take the white part of the extension with one hand.
• With the other hand, wipe the outside of the extension at the MiniCap junction with the disinfectant pad for 15 seconds.
• Let dry.
• Do not remove the MiniCap to clean underneath (the dark blue end of the extension).

Disinfection removes most bacteria from this area before making the connection to the patient line.

• Place the extension on a compress or keep it in your hands.

This step avoids contamination of the extension.

If your child has an adult set, move on to the next step.

• Remove the protective cap from the patient line without touching the end of the line.
• Remove the MiniCap by unscrewing it without touching the dark blue end of the extension.

• Insert the ends into each other and screw firmly.

• Check that the connection between the extension and the patient line is secure.
• Go to step 10.

This step connects the patient line to the catheter extension to enable treatment.

• Open the connection shield package, if used.
• Remove the protective cap from the patient line without touching the end of the line.
• Remove the MiniCap by unscrewing it without touching the dark blue end of the extension.

• Insert the ends into each other and screw firmly.

• Check that the connection between the extension and the patient line is secure.

This step connects the patient line to the catheter extension to enable treatment.

• Install a connection shield around the connection, if recommended by your healthcare team.

The connection shield protects the exposed part of the catheter extension.

• With one hand, turn the white part of the catheter extension counterclockwise.
• With the other hand, turn the light blue part clockwise.
• The two half-moons are no longer interlocked.

This step allows the automated peritoneal dialysis to start.

• Open the patient line clamp.
• Make sure that the clamps on all bags are open.
• Check for kinked, bent, or jammed tubing.
• If your child is in diapers or has a gastrostomy/jejunostomy, wrap a protective pad around the connection.

These checks ensure the proper flow of solutions through the system.

Installing a protective pad around the connection protects it from leaks.

• Press the green GO button on the front of the unit.
• The message “Initial drain” with the programmed volume appears on the screen.
• If the drainage volume displayed is correct, press the GO button again.
• If the drainage volume displayed is incorrect, modify according to the recommendation of your healthcare team
• The message “Initial drain” appears on the screen and the treatment begins.

This step begins the automated peritoneal dialysis treatment with the initial drainage of your child’s peritoneal cavity.

See the full description here

Summary:

The treatment is finished. Wash your hands again.

Be prepared to recognize the challenges faced and to provide positive feedback. Help your child recognize his/her strengths. Acknowledge the collaborative teamwork.

• Listen to what your child says about the parts of the procedure that were difficult or painful.
• Comfort your child and recognize your child’s collaboration with positive feedback.
• Highlight your child’s  specific strengths that helped make the procedure positive.
• Discuss with your child what might be done the same or differently the next time the care is needed.
• Keep your promises if you have promised a reward, follow through.
• Reward yourself too.